Gastrointestinal (GI) malignancies continue to be the second leading cause of cancer-related deaths in the United States (24%). One of the highest shares in GI malignancies belongs to esophagus cancer (10% or 12000-14000 per year based on 2000-2003 statistics). People from the Western hemisphere tend to develop esophageal cancer based on prior metaplastic mucosal transformation often called as Barrett's esophagus (BE). Barrett's esophagus is a cancer risk factor and frequently linked to the preexisting gastro-esophageal reflux disease (GERD). Patients with Barrett's esophagus have a 30-125 fold higher risk of developing cancer of the esophagus than the general population.
Several diagnostic methods exist that do not use any external dyes, such as autofluorescence spectroscopy and imaging, narrow band imaging, Raman spectroscopy, Optical Coherence Tomography and Doppler Optical Coherence Tomography, Laser Scattering Spectroscopy, confocal endoscopy, Infrared Endoscopy. Other methods that use external dyes and staining in vivo include chromo-endoscopy, magnification chromo-endoscopy, and fluorescence imaging of ALA-5 staining.
Recently developed methods are either small field of view and, consequently, very time consuming (Raman spectroscopy, Optical Coherence Tomography, Doppler Optical Coherence Tomography, Laser Scattering Spectroscopy, confocal endoscopy) or require application of external dyes (chromo-endoscopy, fluorescence imaging of ALA-5 staining) Narrow band imaging and near-infrared multimodal endoscopy methods were reported just within last two years and still required to prove its sensitivity and specificity abilities. The narrow band imaging is based on recognizing the irregular pit pattern epithelium islands within areas of intestinal metaplasia. This approach can be significantly affected by human factor and heavily relies upon extensive training of the endoscopist performing the examination.
Accordingly, there is a need for a clinically recognized real-time, large field-of-view screening method to discriminate dysplasia from metaplasia in Barrett's Esophagus.